MEDICARE: LIFE SURGICAL SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1689884603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SURGICAL SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 44
Second Line	:
City	:	POSEN
State	:	IL
Zip	:	60469-0044
Country	:	US
Telephone Number	:	708-825-9329
Fax Number	:	708-658-1701

Provider Business Practice Location Address
First Line	:	1820 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1760
Country	:	US
Telephone Number	:	708-825-9329
Fax Number	:	708-658-1701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDALL L JONES
Credential	:	CSA
Telephone Number	:	708-799-1910

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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Directions to “LIFE SURGICAL SERVICES INC ” Practice Location

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